March 26, 2013 — Ob-gyns should not schedule caesarean-section deliveries at a woman's request unless there is a medical reason to avoid a vaginal delivery, according to an opinion released by an American College of Obstetricians and Gynecologists committee, MedPage Today reports. Maternal-request c-sections without a medical indication account for an estimated 2.5% of U.S. births, according to MedPage Today.
The panel also noted that scheduled c-sections should not be performed before 39 weeks or because a woman has fears about the pain of childbirth. "[P]renatal childbirth education, emotional support in labor, and anesthesia for childbirth should be offered" to women who fear the pain of childbirth, the committee said.
Few studies have examined the risks and benefits of maternal-request c-sections. Considering the available evidence, ACOG's Committee on Obstetric Practice concluded that planned vaginal deliveries resulted in better outcomes than scheduled c-sections for maternal length of stay, neonatal respiratory morbidity, subsequent placenta previa, and acute and subsequent uterine rupture. However, outcomes for maternal hemorrhage were better for c-sections.
Scheduled c-sections are "particularly not recommended" for women who plan to have more children, the committee wrote, noting that research shows the risk of uterine rupture, placental problems and hysterectomy are higher with each subsequent c-section (Neale, MedPage Today, 3/22).